• Journal of Korean society of Dental Hygiene
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• v.5 no.2
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• pp.279-296
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• 2005

The purpose of this study was to examine what types of experiences dental hygienists underwent with patients who were unapproachable in an effort to find out the latter group's needs and expectations, explore how to treat them of different personality type, and provide better dental services in response to their needs. To attain the purpose, Q-methodology was employed, which made a subjective and systematic assessment of human subjectivity. There were three types of subjectivity among dental hygienists in conjunction with their experiences with patients who were hard to please. Each group whose subjectivity was different also had a different preference for patients, which was not exclusive to one another but unique. Type 1 was "avoiding patients who showed off". Dental hygienists of this type found it unpleasant to treat patients who boasted of their background, position or relations with the head of hospital and wanted to be given special treatment. They avoided those patients, since giving special treatment to specific patients was likely to do damage to others. They believed that better medical services could be provided through mutual concern and good manners between medical personnels and patients. Dental hygienists of type 2 considered it hard to treat patients who were picky and looked at treatment or its outcome negatively. Those who had to be separated from others on account of possible cross-infection or who called for special decontamination methods of dental instruments were also difficult to deal with. Dental hygienists of this type could be said to "avoid picky patients", as they preferred to fare with patients by offering good, faithful treatment rather than by giving special treatment. Dental hygienists of type 3 believed that smooth and successful treatment hinged on mutual trust, confidence and collaboration between medical personnels and patients. According to them, patients who choose a specific hospital or a particular medical team at their own option have to cooperate if necessary, listen carefully to medical personnels and treat them without any hostility or bias. Therefore, they could be said to "avoid patients who were not cooperative".

• Clinical Endoscopy
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• v.56 no.2
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• pp.143-154
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• 2023

Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

• Korean Journal of Bronchoesophagology
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• v.2 no.2
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• pp.222-226
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• 1996

The increasing incidence of multiple primary carcinomas occuring in the upper aerodigestive tract is well documented, with the accepted incidence being as high as 20-30%. The fiberoptic endoscopy has also enabled visualization of areas previously inaccessible without general anesthesia. A prospective panendoscopic examination of the upper aerodigestive tract was peformed on 104 patients with squamous cell carcinoma of head & neck in our hospital between 1989 and 1994. Five second primary cancers (4.8% ：2 stomach, 2 esophagus, 1 lung cancers) were detected endoscopically. These finding should reinforce the belief that head & neck cancer is a panmucosal disease of the aerodigestive tract that silent second primary cancers are not uncommon. So every effort should be done to detect second primary cancers in head & neck squamous cell carcinomas. Panendoscopy has proved valuable in achieving that.

• Clinics in Shoulder and Elbow
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• v.23 no.3
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• pp.131-135
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• 2020

Background: Resection of the radial head is a surgical indication for comminuted radial head fracture in which internal fixation is inaccessible. Some complications from the surgery can alter the function of the patient's elbow. The objective of this study was to assess functional outcome of the elbow after resection of the radial head. Methods: A retrospective longitudinal study was performed with patients who underwent radial head resection between 2008 and 2018. Elbow function was assessed by the Mayo Elbow Performance Index (MEPI) for 11 patients comprising three women and eight men. The mean follow-up was 47.6 months. The mean age was 41±10.3 years. Results: Nine patients had a stable and painless elbow. The mean extension-flexion arc was 97.73°±16.03°. The mean values of pronation and supination were 76.8° and 74.5°, respectively. The mean MEPI score was 83.2 points, and restoration of overall function was achieved in 81% of the cases. Poor function was noted in one in 10 that presented with a terrible triad. Conclusions: Resection of the radial head restored elbow functionality at a rate of 81%, which was a good outcome for patients.

• Journal of Korean Neurosurgical Society
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• v.59 no.1
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• pp.17-25
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• 2016

Objective : Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. Methods : Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. Results : All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed ${\geq}2$ times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. Conclusion : Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route.

• Tuberculosis and Respiratory Diseases
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• v.78 no.2
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• pp.47-55
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• 2015

Extrapulmonary tuberculosis (EPTB) constitutes about 20% of all cases of tuberculosis (TB) in Korea. Diagnosing EPTB remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus decreasing the sensitivity of diagnostic tests. Whenever practical, every effort should be made to obtain appropriate specimens for both mycobacteriologic and histopathologic examinations. The measurement of biochemical markers in TB-affected serosal fluids (adenosine deaminase or gamma interferon) and molecular biology techniques such as polymerase chain reaction may be useful adjuncts in the diagnosis of EPTB. Although the disease usually responds to standard anti-TB drug therapy, the ideal regimen and duration of treatment have not yet been established. A paradoxical response frequently occurs during anti-TB therapy. It should be distinguished from other causes of clinical deterioration. Surgery is required mainly to obtain valid diagnostic specimens and to manage complications. Because smear microscopy or culture is not available to monitor patients with EPTB, clinical monitoring is the usual way to assess the response to treatment.

• Journal of Chest Surgery
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• v.47 no.2
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• pp.111-116
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• 2014

Background: We aimed to investigate the epidemiological, clinical, paraclinical, and treatment aspects of elastofibroma dorsi through a retrospective study of 76 patients who underwent surgery between January 2008 and December 2012 in our department. Methods: Our study is retrospective between January 2008 and December 2012. We admitted 79 patients with a subscapular mass, and only 76 patients had ED. The others (n=2) had high associated risk of anesthesia and were managed by a medical treatment and one patient had a subscapular sclerotic hemangioma. Results: The average age of the patients was 49 years (range, 38 to 70 years), with a female predominance (54 females and 22 males). Subscapular location was constant. The right, left, and bilateral form was noted in 41, 15 and 20 cases, respectively. The diagnosis was clinical in 60 cases. Ultrasound and computerized tomography scans confirmed the diagnosis of an ill-defined mass in a subscapular location in all cases. Surgical treatment consisted of complete resection of the mass. The clinical diameter of the mass remained significantly lower than that of the surgical specimen (7 cm versus 12 cm) because the major hidden part of the mass in the subscapular area was inaccessible to palpation. Complications were noted in 9 cases (11.8%), seroma in 8 cases (10.5%), infection of wound site in 4 cases (5%), and parietal textilome in one case (1%). No case of recurrence was noted. Conclusion: Surgery of elastofibroma is unique because of the subscapular location of the parietal tumor, whose histological fibrous nature makes it very adherent to the chest wall.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.654-660
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• 2017

Objective : Mechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ${\geq}80$ years) and aged patients (60-79 years) treated with mechanical thrombectomy. Methods : Between January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy. They were divided into a very elderly (${\geq}80$ years) and aged (60-79 years) group, with comparisons in recanalization rates, complications, death and disability on discharge be reported. Results : The mean age was 70.3 years in the aged group and 83.4 years in the very elderly group. Elderly patients had higher rates of mechanical thrombectomy failure than the younger group (40% vs. 14%; odds ratio [OR] 4.1; 95% confidence interval [CI] 1.4-11.9; p=0.012). Results from thrombolysis in cerebral ischemia and modified Rankin scale at discharge were worse in the older group (p=0.005 and 0.023 respectively). There were no differences in mortality rate or other complications, but infarction progression rates were significantly higher in the very elderly group. (15% vs. 2.2%; OR 8.0; 95% CI 1.2-51.7; p=0.038). The majority (92.3%) of the patients who failed in aged group were not successful after several trials. However, in half (4 of 8) of the very elderly group, the occlusion site could not be accessed. Conclusion : Patients older than 80 years of age undergoing mechanical thrombectomy for acute infarction were more difficult to recanalize due to inaccessible occlusion sites and had a higher rate of infarction progression, However, mortality and other complications were similar to those in younger patients.

• Journal of Periodontal and Implant Science
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• v.38 no.4
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• pp.737-744
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• 2008

Purpose: In advanced case of periodontitis, surgical treatment without bone contouring may result in residual pockets inaccessible to proper cleaning during post-treatment maintenance. This problem can be avoided or reduced by applying guided tissue regeneration. Materials and Methods: All of 3 patients had deep periodontal pocket depth and bleeding on probing, and radiograph revealed osseous defect, so we planned guided tissue regeneration using resorbable membrane with or without xenograft. Result: 6 months later, periodontal pocket depth and bleeding on probing was improved and gingiva was stable. Conclusion: Guided tissue regeneration using resorbable membrane with or without xenograft in osseous defect is predictable.

• Journal of Yeungnam Medical Science
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• v.3 no.1
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• pp.53-62
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• 1986

In the past 10 years, modern technology has made deep seated obscure lesions visible. With development of computer technology and various stereotaxic techniques, many new procedures. refinement of old procedures, and development of new applications are possible. The authors are intended to provide a detailed description of our experience with the Brown-Roberts-Wells(BRW) stereotactic system in the evaluation and management of 90 patients with intracranial lesions, and to provide cases presentation of various inaccessible intracranial lesions.